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Saturday, June 30, 2012

What I Read
in the Wall Street Journal about ObamaCare

You want to call it ObamaCare – That’s
OK because I do care.

President
Obama, Atlanta Fund Raiser, March 26, 2012

All I know is just what I read in the
papers.

Will Rogers
(1879-1935)

June 30, 2012 -The Wall Street Journal
is a conservative business paper with the nation’s largest newspaper
circulation.

The Friday June
28 and Saturday June 29 editions contain 17 articles on the Supreme Court decision.

I shall quote from them now.

1.Court
Backs Obama on Health Care– “ The ruling means that the law’s reordering will
move forward mostly as planned, with
implications affecting every hospital, doctor, health insurer, and drug maker in the nation.”

2. Roberts
Straddles Ideological Divide -“The
ruling is both a political and constitutional landmark. It is a measure of
validation for President Obama’s political achievement .and cast a new light on
Chief Justice Roberts, who had been frequently attacked as Republican partisan
but managed to defy that view while reinforcing some long standing conservative principles.

3. Unwanted ‘Tax’
is Savior for Law -“He never wanted to
think of it as a tax.But the measure
survived because the high court ruled the enforcement tool at its core as a
tax. The court’s act may prove grist for Republicans for the election-year
argument that Mr. Obama is a classic tax-and-spend liberal.

4.Obama’s Big Legal Victory Sets Stage for More
Battles – “President Obama won a monumental legal victory,But the fight for public opinion – and votes
in November, showed signs of growing more heated.”

5.For Health Sector: Forward March – “The
Supreme Court decision largely upholding the health-care laws lifts the
uncertainty over the health-care industry and puts companies back on course to
prepare for the law’s implementation over the next two years.”6. Medicaid Decisions Loom for States - The Supreme Court’s decision to let states
opt oot of the health overhaul’s Medicaid expansion without losing current funding
lifts a budget mandate from states but could mean fewer Americans gain
insurance coverage under the law.”

7. For Millions,
Coverage Begins in 2014 – “Most consumers can expect to keep seeing increases
in premiums because the underlying cost of health care is expected to rise.”

8. The Obamacare
Election – “By upholding sweeping federal
power, the Supreme Court has raised the November stakes – and given Romney an
opening.”

13. Triumph
and Tragedy for the Law.“The Supreme
Court decision is a triumph and tragedy for our constitutional system.” Upholding Obamacare’s mandate as a kind of ‘tax,’
the court itself engaged in a quintessential activity – redrafting the law’s unambiguous
text."

14. Obama
Has a Good Day –Republican backers of Mitt Romney have been feeling pretty confident,
and understandably.Their challenge now is
to make the most of the moment.They
will have the help of their base, which is, at the moment, angry as hornets, loaded
for bear, and fully awake.”

15. Chief
Justice Roberts and his Apologists – “Some conservatives see a sliver lining in
the Obamacare Ruling.But it’s exactly
the big-govenmetn disaster it appears to be”

16.ObamaCare: Upheld and Doomed – “Regardless of the Supreme
Court, fiscal reality will prevail. The lsat thing we needed , in a country
staggering under deficits and debt and
an unaffordable entitlement structure, was a new Rube Goldberg entitlement.”

17. The Tax
Duck- “The duck test – if it looks like
a duck, swims like a duck and quakes like a duck, it probably is a duck."

This book delivers comprehensive, but easy to read discussions
concerning the uncertainty, the threat of lower reimbursements, and what
practices can do in response to reform. The entry format allows the reader to
even pick and choose from the sections without having to read straight through.
Dr. Reece delivers a balanced (and less judgmental) overview of the reform.
Because of its multiple points of view and various perspectives, it tells you
everything you may want to know about health care reform but were afraid to
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Dr. Reece approaches the unclear issue from the patient and the
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Part
One:Culture and Politics, the Reform Law, Costs and Demands, and
Unforeseen ConsequencesPart Two:Physicians, Hospitals,
Patients, Access to Doctors, Medicare, Medicaid, Government
Bureaucracy

Part Three:Innovation, Electronic Health
Records, the Internet and Social Media, and Miscellany

About
the Author:

Richard L. Reece, MD, pathologist, writer, and
editor, is former Editor-in-Chief of Minnesota Medicine and Physician Practice
Options. He has written 10 books on the healthcare system. For the last four
years, he has written a blog, medinnovationblog, which includes 1700 entries on
healthcare innovation and reform. Dr. Reece stresses that physicians and
patients must work together more closely to build a more personal,
patient-centered system without massive interventions by third parties. Dr.
Reece was educated at Duke University School of Medicine with postgraduate
training at Hartford Hospital and had training at Harvard Business School.

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--

Friday, June 29, 2012

Pyrross,
King of Epirus, in Plutarch’s Phyrhus, meaning a victory that harms the victor more than the vanquished

No human wisdom can calculate the
end. It has but one thing certain, and that is to increase the taxes.

Thomas Paine
(1737-1809), Prospects on the Rubicon

June 29,
2012 - It has been 24 hours since the Supreme Court ruled. In those 24 hours I have received a near
record number of hits on my blog and phone calls asking for my read on the
situation.

After a day
of mental digestion, I conclude Obama won a Pyrrhic victory which may cost him
the election in November.He won the judicial
constitutional battle, but lost the policy war.In this time of record deficits and record
spending, public attention shifted from constitutional issues to taxation issues
stemming from a deeply unpopular health law that will require unprecedented levels of
taxation, which will fall on everybody, particularly the middle class.

As far as
doctors are concerned,the decision, as
the Doctor Patient Medical Association, said is “A slow motion disaster,” which if implemented,
will strip doctors of their autonomy, income, status, and flexibility.

As I said in a previous post in November
2010, “Impact of Obamacare on Doctors,”

“59% of doctors think the quality of medicine
will decline in the next five years and 79% are less optimistic about the
future of medicine. 69% are thinking about dropping out of government health
programs, 53% would consider opting out of treating insurance-covered patients,
and 45% have considered leaving the profession altogether.”

The Court decision does not change those
figures.

The
spinmeisters have made their statements, the consensus is that the Court and
Chief Justice Roberts handed Obama critics a golden opportunity on a silver
platter, if I may use a precious metal metaphor.

The Supreme Court
moved the debate from the judicial box to the ballot box. The Court focused on the constitutionality of government’s
power to tax.And it drew rapt and undivided attention
to the monumental tax burden the health law will bring if Obama is re-elected -
$400 billion already in the pipeline,trillions more as Bush tax cuts are phased
out, the estimated $1.76 trillion to $2.5 trillion the law will cost from 2014
to 2024,much of which will fall on the
middle class and future generations.

Here is how
Douglas Holtz-Eakin , a distinguished economist and present of the American Action
Forum, reacted,

“The
field of play now shifts from a legal battle to a policy debate. In addition to
the Court's endorsement of the policy foundations of the challenge to the ACA,
the fundamental policy flaws remain."

"The ACA remains a damaging, anti-growth vehicle for taxation. The so-called
Medicare surtax increases marginal tax rates on the return to saving,
investment, and innovation. The medical device tax will hurt innovation and
cost jobs. A bill to repeal it is gathering dust in the Senate. Also, the
insurers fee - the "premium tax" - will roil insurance markets,
disrupt patient-provider relationships, and the vast majority of the burden
will fall on the middle class. "

"The ACA remains an unwise expansion of entitlement programs at a dangerous
fiscal moment in U.S. history. The U.S. has suffered a downgrade, has a
debt-to-GDP ratio over 100 percent - a level historically associated with 1
percentage point slower growth and a heightened probability of financial crisis
- and faces a spending-driven explosion of debt over the next decade. Also, the
ACA does not reform Medicare, which has a cash-flow deficit of nearly $300
billion annually and is responsible for one-fourth of all federal debt since
2001.”

I close with a quote from Winston Churchill. After his defeat as
Prime Minister after World War II, his wife Clementine told him, “This
may be a blessing in disguise." Churchill replied, “If this is a blessing, it
seems quite well disguised.”

Tweet:Supreme Court ruling that the individual mandate
is constitutional is a Pyrrhic victory for the Obama administration.

Thursday, June 28, 2012

Confusion: My Reaction to Supreme
Court Ruling

Confusion hath made his masterpiece!

Shakespeare (1564-1616), MacBeth

June 28, 11AM -My first reaction to
the Supreme Court decision is confusion.The ruling upholds the individual mandate as a tax,but strikes down the law as a vehicle for expanding
Medicaid access in the states.

The ruling
is a victory for the Obama administration and a relief for Democrats.It enhances Obama’s chances in
November.It is a challenge for
Republicans, but it may energize their base into turning out in November to
elect a President and Congress to repeal Obamacare.

It’s still
too early to foretell what it all means.

Here is what
headlines in national newspapers say.

·“Health
Law Stands: Roberts Joins Majority Affirming Mandate, Victory for Obama, But
Ruling Limits Medicaid Expansion” New
York Times

The ruling disappoints
and confuses me for two reasons. One, President
Obama has said repeatedly the law was not a tax. Two,I
thought the intent of the law was to expand access to care in the states via
Medicaid expansion.

The stage is
now set for a vigorous debate between now and November, with sides takes their
shots and offering their spin on Obamacare consequences.

Let the
people decide. Maybe they will help clear up the confusion.

Tweet: Supreme
Court upholds the Individual Mandate but limits expansion of Medicaid in the
States – a confusing and contradictory ruling.

Wednesday, June 27, 2012

"Health
Policy Groups Prepare for a Day of Spin", from Capsules the KHN Blog

We owe to our ancestors to preserve entire those rights, which they have delivered to our care; we owe it to your posterity, not to suffer thier dearest ineritance to be destroyed.

The Letters of Junius 176-1771)

June 27, 2012 - Here are some ways health policy groups
are preparing for Thursday’s decision:

·The National Federation of Independent Businesses’ Legal
Center has scheduled a media conference call for Thursday at noon. The group,
which is one of the plaintiffs in the challenge to the federal health law, will
also host a live-chat
on Thursday at 1:00 p.m.

·Virginia Attorney General Ken Cuccinelli, also a
plaintiff, will host a live news conference in Richmond, Va., and
teleconference call on Thursday at noon, after he has had an opportunity to
study the ruling. The attorney general will also send out an immediate reaction
to the ruling at 10:15 A.M. A link to the video press conference will be posted
on Cuccinelli’s website.

·The National
Health Council, a patient advocacy group comprised of more than 100
member organizations, created their own website
dedicated to the Supreme Court’s decision. The group will be posting
statements, documents and other responses from their member organizations on
the website on decision-day.

·The National Council of La Raza,
a civil rights and advocacy group for the Latino community, will be hosting a Twitter-chat
Friday to broadcast their reactions and to explain what kind of impact they
expect the Supreme Court’s actions will have on Latino, LGBT and female
Americans.

·Young
Invicibles, the advocacy group that focuses on young adult health
care issues, is holding a press call at 12:30 p.m. Thursday. On the same day,
the group is going to host a Twitter-Chat (@YI_Care) at 1 p.m., using the hashtag
#Young AmerChat.

·The National Coalition On Health Care
said they will release a statement on Thursday. Their president and CEO John
Rother is already scheduled to talk to media on the day of the decision.

·Avram Goldstein, a spokesman for Health Care For America Now!
said that on Thursday, their partnerships around the country will conduct
various events from rallies to press conferences. “Each group does its own
thing in a different way. Maybe going to a hospital, maybe visiting an Attorney
General’s office, maybe visiting a member of Congress.” He said that his
organization is going to have a spreadsheet of all the different events
happening around the country and will share it with the public on the day of
the Supreme Court decision.

·The CATO
Institute initially planned to host a policy forum on June 28th,
but pushed their event to July 2nd now that the Supreme Court is
going to make a decision on the 28th. The forum, which will address the impact
of the Supreme Court’s decision on the health care law, will include Randy Barnett
from Georgetown University Law Center, Avik Roy from the
Manhattan Institute and Grace-Marie
Turner from the Galen Institute.

·Health
Affairs, the peer-reviewed health care journal, is hosting an event
on Friday, June 29th at Georgetown University’s Law Center to talk about how
the Supreme Court’s decision will affect Americans. Their panel includes: David B. Rivkin, a lawyer
who representing the 26 states that challenged the constitutionality of the
health care law, M. Gregg
Bloche from Georgetown University and author of The Hippocratic
Myth: Why Doctors Are Under Pressure to Ration Care, Practice Politics, and
Compromise Their Promise to Heal, and Sara
Rosenbaum, a professor at George Washington University School of
Public Health and Health Services who helped draft part of President Clinton’s
health care proposal.

This entry was posted on Wednesday, June 27th, 2012 at
8:43 am.

Two Responses
to “Health Policy Groups Prepare For Day Of Spin”

# One Response, If the high court rules
to fully uphold Obamacare, the biggest winners will be the private insurance
companies. They will see 30 plus million new subscribers enter the health care
insurance market. Next in line in the winners circle will be the hospitals.
They will see a dramatically reduced volume of charity care as less uninsured freeloaders
will be walking into their emergency rooms expecting free “mandated” charity
health care. If the high court does as Republicans want them to do and they
strike down Obamacare, we will all go back to business as usual in a broken
fee-for-service health care system that is twice the cost of any other nation
on earth and ranks 37th worldwide in delivery and efficiency. We will return to
insurance companies canceling your policy if you get sick. Students and other
young adults will get tossed off their parent’s policy. Seniors will see Donut
Hole relief end and they will also see the end of free preventive testing. No
wonder Republicans are called Neanderthals and Tea Party cave dwellers

#2 Response - My
response to first response

This is fairly
typical elitist spin,

Namely,
should the GOP win,

It will be a
triumph of the Neanderthal

A victory
for the cave dwellers folderal

Only
liberals, you see, have minds,

Others
represent mankind’s behinds.

Only Obama
et al have real compassion,

Conservative
shutdown is out of fashion.

Only libs
know how to spend others’ money,

Even if it’s
not there, which is not so funny.

My
question:what speaks of more intelligence,

Spend it
now, or save future generation's inheritance.

Tweet:Various health industry groups are preparing
their win-lose spins on tomorrow’s Supreme Court decision on
Obamacare, and how it will effect the election and health reform future.

June 27, 2012-Tomorrow, Thursday,is Decision DayWhatever the Supreme Court decides, there
will be plenty of apocylyptic doom and gloom, and promise of economic boom to go around.

Should it go
down, Democrats will be full of doom and gloom.Their signature domestic achievement will be in shreds.However one tattersit,this would be bad news for the
November election. It would leave them
little to run on, and much to run away from.

Yes,
Obamanites could blame Congress for
obstructionism and the Supreme Court for partisanship.But they can’t blame the American public,
who will welcome news of judicial repeal. And they can’t escape the colossal political blunder of focusing on health reform rather
than the economy.

As for the
Republicans,there will be cheers and
spiking of the ball in the end zone. Perhaps the end zone should be called the
start zone.For the GOP must now come up with a plan to
move the ball up the reform field again.For the GOP, the good news may well be another kind of spike – a spike
in hiringas the economic uncertainties
of Obamacare disappear. But, alas, an economic recovery spikein the 130 days before the election could
favor Obama.

Should it be
upheld.Well, that’s another kettle of
fish. Democrats will no doubt rejoice.Republicans will pray for a political sweep in November and a second
chance at repeal.

Should the
decision be mixed, with turndown of the mandate and retention of other
elements, that’s beyond the scope of this post.

Tweet:Tomorrow the Supreme Court announces its decision on Obamacare which will
be met with a mix of doom, gloom, and promise of an economic boom.

June 26, 2012 -Practicing physicians are not zoo animals.But sometimes they feelcaged mammals as they spend up to 1/3 of their time abiding
by, complying with,being threatened by federal regulations , begging for permission to perform tests, and taking the blame for raising costs of
health by ordering “unnecessary” tests and procedure to fend off possible
future malpractice suits.

Meanwhile
physician incomes, dictated in large part by a coding system devised and guided by
the federal government and the AMA, has kept their income flat for over a
decade while expenses have been rising 4%to 5% each year.

In survey
after survey, doctors complain of “harassment” and “hassle” by third parties, parmamout among these Medicare, as they struggle
to maintain their practices, lifestyles, and sanity.

Small wonder, then, that 2/3rds of physicians believe Obamacare will
lower quality of care, decrease their autonomy, reduce their incomes, and make
the practice of medicine less attractive. Small wonder that 25, 000 new physician are entering
practice each year while 35,000 are leaving the profession.

Small wonder that a political access crisis
to physicians looms in three to 5 years, as 30 millon more Medicaid patients enter
the government rolls in 2014, and 10,000 baby boomers became Medicare eligible each day for the next 18 years.

Doctors’
reaction and resistance to Obamacare, of course, is only one factor in the politics of health reform, and it is
seldom mentioned as the Supreme Court announces its decision on the
constitutionality of Obamacare in two days on June 28, but I submit it is an
important consideration, for it is physicians who must deliver the care under
the provisions of Obamacare.

Health
reform is a complicated and difficult proposition to implement in the US for
many reasons beyond the scope of this blog.

But in a
previous post, in September 2009.I
touched on some the reasons why.

You might
enjoy rereading this post, which I reprint now.

December 23, 2009

Government
Care-Why Reform is Difficult: It's the U.S. Form of Government

In today’s The Health
Care Blog, Humphrey Taylor, Chairman of the Harris Poll and Harris
Interactive, speculates why U.S. health reform is more difficult than in other
countries.

He gives these reasons. The comments are mine.

ONE, their systems are much simpler, i.e., they don’t have a thousand points of
payment. Comment: In America, we call this freedom and choice.

TWO, they already have universal coverage and can focus on improving care,
efficiency, and cost containment. Comment: In other words, government rules
and trumps private sector.

THREE, they have parliamentary systems, where a simple majority rules. Comment:
“Simple majorities” can lead to social tyranny.

FOUR, lobbies, i.e. special interests, are more influential in the U.S. Comment:
The biggest “special interest” of them all is a dominant unchecked politic
party.

FIVE, the power of money: in other countries elected officials do not have to
raise vast amounts of money to be elected. Comment: I agree. A prime example
is Barack Obama, who raised unprecedented amounts of money from Wall Street and
Internet followers.

SIX, they only need a bare majority of votes in their legislature and have no
such thing as a filibuster. Comment: Good point. Our founding fathers set up
a system to frustrate sweeping changes by a “bare” majority.

SEVEN, the U.S. has partisan news networks, especially Fox News, and talk radio
that spread emotional, often misleading arguments that fuel populist feelings,
and dumb down the debate. Comment: This is typical elitist rhetoric, that
somehow those in D.C. and liberal media have a stranglehold on intellect,
wisdom, and objectivity.

Tweet:Health reform is difficult in the U.S
because of our constitution, our distrust of government, and our desire for clinical
freedom.

June 26, 2012 – On Thursday, June 28, we shall learn if the
liberal echo chamber- Democrats, the
media, and academics talking to each other and closing their ears to voices
outside the Beltway – have heard what the Supreme Court thinks of health
reform correctly.

Here is how
Hugh Hewitt, in the Hewitt Bolog describes what happens when you listen only to
your own bugles. Hugh
Hewitt (born February 22,
1956) is an American radio talk show host with the Salem Radio Network, lawyer, academic, and
author.

"Now we have the great
pipe organ of the left wheezing out a dirge about how the left and its party
never saw it coming. And why were Democrats taken by surprise? Because, the
paper tells us, they relied on the brilliant Pelosi and the Chicago gang who
said there was nothing to worry about in this crazy talk about enumerated
powers and the limits of the Commerce Clause. You have to read it to capture
the full force of their shock. They genuinely didn't know that there would be a
serious challenge, which means they shuttered their ears to the chorus of
warnings that steadily rose over the two years it took to jam the disaster down
the throat of America."

"The costs of Obamacare
have already been vast and the dislocations it has already brought about terrible
--especially its drag on job creation-- but the one good thing it may have
produced is this article and its enduring value as "an admission against
interest" by the left about the left's lack of basic constitutional
literacy and its indifference to argument and facts."

This is another way of saying one man's intellectual is another man's ineffectual.

Tweet;One man’s echo chamber is one man’s bugle and
another man’s trumpet and chamber pot.

Two, although the health law will cover an estimated 56 million uninsured
and underinsured in 2014,at present
(2012) it covers a much smaller number
of Americans.

·3.1 million young
adults now covered up to age 26 under their parents’ plans.

·651. 000
Americans with pre-existing illness who
have been denied coverage by the four major insurers over the last 3 years (and
possiblya million or so more if one includes
all insurers ( insurers now accept 9 of 10 with pre-existing illness albeit at
high rates).

·1.2 million
seniors falling into the donut holewho
now receive 50% discounts on drugs)

Three, There are four possible scenarios of Supreme Court ruling, now expected on Thursday, June 28. These scenarios will effect different Americans in different states in different ways.

1. The entire law is upheld.

2. The insurance mandate is struck down, but the entire rest of the law stays.

3. The manadate and two related provisions are struck down, but the rest of the law stayes.

4. The entire law is struck down.

Tweet:The publicopposes Obamacare bya large margin (10.8%), but the law so far
directly effects only about 6 million Americans.

The Health Reform Maze

Buy the Book

Book Description: In this first book in a series of four, Richard L. Reece, MD. provides a unique view of the roll out, and run up, of the Affordable Care Act. Reece shows in this book the progress and facets of ObamaCare's marketers and messengers, as the day approached for the launch of health insurance exchanges - the single most public and problematic portion of the new law. This is a must read for anyone who wants to chronicle this attempt to organize more than one-sixth of the U.S. economy by adding layers of federal government control and regulations.

Reece has been writing about U.S. health care for more than 45 years. His knowledge and experience, added to his keen intellect and gift of subtle humor, make this book a valuable part of anyone's collection.